In a fascinating presentation hosted in March by the Oxford Uehiro Centre in Practical Ethics, Professor Seumas Miller spoke about what is now known as ‘moral injury’ and its relation to PTSD, especially in the context of war fighting and police work.

Miller began by explaining the standard view of moral injury, as used in the work of, for example, Nancy Sherman and Jonathan Shay. Like PTSD, it arises from highly stressful events, such as events threatening one’s own life or the loss of a comrade. PTSD can be said to consist in extreme mental distress, involving fear, depression, and other negative states, along with physical or cognitive impairments, such as memory loss or insomnia. Moral injury is usually taken to be a species of PTSD which involves experiences, such as the killing of an innocent, that involve the violation of an individual’s own moral values.

Miller, however, argued that PTSD is in effect a species of moral injury. He first outlined the notion of what it is involved in caring about something which, or someone who, is worthy of being cared about. Objects of such care might include one’s own life, the lives of one’s comrades, one’s own autonomy, and the approval of others. If any of these is taken away, the moral identity of the ‘caring-self’ will itself be damaged.

At this point, Miller focused in particular on war fighters and police officers. These individuals deeply care about the things most human beings deeply care about, but they are also willing to put themselves in harm’s way and to use potentially harmful methods to achieve their goals. Consider in particular the concern such people often have for honour, as it consists in loyalty, self-discipline, and so on. These virtues are clearly elements of their moral identity.

We can now understand how, on a care-based account, the relation between moral injury and PTSD can be differently understood. Moral injury mightinvolve the sufferer’s acting wrongly or wrongdoing, but it need not. The traumatic event causing PTSD undermines core elements of their moral identity. PTSD, then, turns out to be a species of moral injury, rather than the other way round.

Miller then turned to the issue of ‘dirty hands’ and moral injury. First he noted the possibility of conflict between an individual’s role identity (as, say, war fighter) and their inter-personal identity (as, say, father). Consider cases in which a war fighter kills an enemy terrorist, guilty of terrible war crimes, or an innocent civilian, believing the killings to be both morally and legally prohibited. (Structurally similar cases can be imagined for police work, involving the treatment of criminals and innocent parties.) Such actions might be placed in the category of ‘dirty hands’ – legally and morally prohibited actions performed for good ends. It is easy to see how considering such actions and then performing them can lead the agent down a slippery moral slope, in which such actions become habitual, and also how – given the conflicts between identities mentioned above – can lead to moral injury and indeed PTSD.

There may be responses available for the defender of the ‘standard’ view of moral injury and its relation to PTSD. Miller himself allowed that we can distinguish PTSD into two types, mirroring the phenomena described in the standard view as PTSD and moral injury – i.e., those which involve moral responsibility in some respect, and those which do not. But it may well be that the moral/non-moral distinction at work in the standard view is less significant than it appears at first sight, and so the pressure Miller puts on that distinction, and his articulation of a more capacious evaluative alternative in the notion of moral identity, is a very welcome intervention in the debate.

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